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Binge-eating disorder (BED) was first included as its own diagnostic entity in the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) within the Feeding and Eating Disorders section.1 BED’s hallmark feature is recurrent binge eating, involving the consumption of an amount of food that is definitively larger than what others would eat under comparable circumstances within a certain time, associated with a feeling of loss of control over eating. Diagnosis of BED according to DSM-5 (307.59) requires this objective binge eating to occur at least once per week over 3 months. In contrast to binge eating in bulimia nervosa, binge eating in BED occurs without regular inappropriate compensatory behaviors aimed at preventing weight gain, such as self-induced vomiting, fasting, or laxative misuse. Binge eating in BED is further characterized by behavioral abnormalities, such as eating rapidly or until feeling uncomfortably full, and results in marked distress.

Sedan TV-apparaten uppfanns har man varit begränsad till linjär-Tv, både när det gäller utbud och antal avsnitt. Antalet kanaler har ökat och därigenom även antalet program användaren kan kolla på. Men tittandet sker fortfarande på en och samma stationära TV. Med utvecklingen av Video on Demand-tjänster (VoD) kom möjligheten att titta på serier var man vill och hur man vill. Detta nya medium utvecklade nya tittarmönster. Ett av dessa är binge-watching som inte så många har hört talas om men som många har en stor koppling till. Begreppet innebär att konsumenten ägnar sig åt att sträcktitta på en TV-serie. De flesta digitala tjänster försöker fokusera på att behålla publiken en längre tid framför skärmen för att tjäna mer pengar och därför utvecklar de plattformar med funktioner som uppmuntrar till binge-watching. Det är av intresse för hela samhället att förstå varför vi blir övertalade att titta längre på serier för att kunna förstå sina tittarbeteende och därigenom kontrollera dem. Syftet med vår studie är att undersöka vilka faktorer som uppmuntrar mest till binge-watching. För att svara på vår frågeställning ska vi också svara på arbetsfrågorna: “Vilka faktorer hos Netflix och Viaplay uppmuntrar mest till binge-watching?” och “Vilka externa faktorer uppmuntrar till binge-watching?” För att få svar på de frågorna har 17 medieteknikstudenter från KTH dagligen under en hel vecka fått svara på en logg angående sina tittarvanor. Vi har också genomfört semistrukturerade intervjuer för att kunna fördjupa oss i deras användning av VoD-tjänster. Vårt arbete gav bra och användbara resultat med hjälp av de kvalitativa - och kvantitativa metoder vi skapade. De kan användas i en framtida undersökning om tv-tittande för att nå en publik som binge-watchar och därigenom utveckla studien. Resultatet visade att den automatiska uppspelningsfunktionen påverkar tittarna till att fortsätta titta vidare på en serie där bara 5 av användarna kunde motstå funktionen. Vi kom också fram till att tittarmiljön och valet av elektronisk enhet bidrog till ett ökat maratontittande. Mer än hälften av deltagarna föredrog att titta på serier på en större skärm. Många av dem erkände att TV och en skön soffa eller säng uppmuntrar till binge-watching. Undersökningen visade också att det inte bara är tekniska funktioner som uppmuntrar till binge-watching utan också tiden som användaren kan ägna åt deras tittande samt orsaken till tittandet. Studien visade att många funktioner hos båda VoD-tjänsterna liknar varandra. Den största skillnaden var att i Viaplay är det möjligt att pausa den automatiska uppspelningsfunktionen medan Netflix kan man inte pausa nedräkningen. Ingen av våra deltagare kände till den möjligheten hos Viaplay och därför kunde vi inte dra några slutsatser kring huruvida denna skillnad mellan tjänsterna uppmuntrar till binge-watching. / Since television was invented one has been limited to linear television, both in terms of programs and the number of episodes. The number of channels has since then increased as has the number of available programs. But the watching still takes place on the same TV-set. With the introduction of the Video on Demand services (VoD) one got the opportunity to watch TV series wherever and wherever one wants. This has triggered new viewing patterns. One is binge-watching, a concept that many are unfamiliar with, even though many actually watch TV in that way. The term means that the consumer watch several episodes of a TV series at a time. Most digital services try, due to financial reasons, to extend the time the viewers spend at the TV, and therefore they develop platforms with features that encourage binge-watching. It is in the interest of the whole community to understand why and how we are persuaded to look longer on series in order to understand our viewing behavior and thereby stay in control. The purpose of our study is to investigate what factors that encourage the most to binge-watching. To answer this we also choose to look into: "What factors in Netflix and Viaplay encourage binge-watching the most?" and "Which external factors encourage binge-watching?". To find answers we took help from 17 media technology students at KTH that daily during a week was asked to logg their viewing habits. We have also conducted semistructured interviews with them to get in-depth knowledge of their use of VoD-services. Our work provides interesting and useful results based on the qualitative and quantitative methods we used, and is a good foundation for future studies of television viewing aimed at better understand the binge-watching phenomena. Our study shows that the autoplay function encourage viewers to continue to watch series. Only five of our study participants could resist this feature. We also conclude that the comfort-level of the viewing environment and the choice of electronic viewing device influence the tendency to marathon view. More than half of our study participants prefer to watch series on a larger screen. Many of them acknowledged that a TV-sized screen and a comfortable couch or bed encouraged binge-watching. Not only technical features encourage binge-watching. Also the time the user can devote to their viewing and the reason for viewing influence it. The study showed that many features in both the studied VoD-services are very similar. The biggest difference between them is that it in Viaplay is possible to pause the autoplay function while you can not do this in Netflix. But none of our participants knew that Viaplay had this feature and we could therefore not draw any conclusions as to whether this difference affected the binge-watching or not.

Objective: Binge-eating disorder (BED) is characterized by recurrent episodes of binge eating and is associated with eating disorder and general psychopathology and overweight/obesity. Deficits in cognitive and emotional functioning for eating disorders or obesity have been reported. However, a systematic review on cognitive and emotional functioning for individuals with BED is lacking. Method: A systematic literature search was conducted across three databases (Medline, PubMed, and PsycINFO). Overall, n = 57 studies were included in the present review. Results: Regarding cognitive functioning, individuals with BED consistently demonstrated higher information processing biases compared to obese and normal-weight controls in the context of disorder-related stimuli (i.e., food and body cues), whereas cognitive functioning in the context of neutral stimuli appeared to be less affected. Thus, results suggest disorder-related rather than general difficulties in cognitive functioning in BED. With respect to emotional functioning, individuals with BED reported difficulties similar to individuals with other eating disorders, with a tendency to show less severe difficulties in some domains. In addition, individuals with BED reported greater emotional deficits when compared to obese and normal-weight controls. Findings suggest general difficulties in emotional functioning in BED. Thus far, however, investigations of emotional functioning in disorder-relevant situations are lacking. Discussion: Overall, the cross-sectional findings indicate BED to be associated with difficulties in cognitive and emotional functioning. Future research should determine the nature of these difficulties, in regards to general and disorder-related stimuli, and consider interactions of both domains to foster the development and improvement of appropriate interventions in BED.

A sizeable body of research has documented Expressed Emotion (EE) to predict clinical outcomes in various psychiatric disorders, including eating disorders. Patients’ perceptions of relative’s EE, however, were found to play an important role in the processing of EE. This study aimed to examine the level of perceived EE in adolescent binge-eating disorder (BED) and its impact on eating disorder psychopathology. Adolescents (12 – 20 years) seeking treatment for BED (n = 40) were compared to adolescents without current or lifetime eating disorder (CG; n = 40). Both groups were stratified according to age, sex, body mass index (BMI, kg/m2), and socio-economic status. The Five Minute Speech Sample (FMSS) and the Brief Dyadic Scale of EE were administered to assess patients’ perceived maternal EE. Additionally, adolescents and mothers completed questionnaires on eating disorder and general psychopathology. On the FMSS, 37.5% of patients with BED perceived their mothers as high EE (vs. 12.5% in the CG). On the Brief Dyadic Scale of EE, patients with BED reported significantly higher levels of perceived maternal criticism, emotional overinvolvement, and lower levels of perceived warmth than controls. After controlling for the diagnosis of BED, perceived criticism and warmth, as assessed by questionnaire, significantly explained adolescents’ global eating disorder psychopathology. Negative perceptions of maternal behavior and emotional atmosphere towards the child are characteristic of adolescent BED. As documented for other eating disorders, family factors are likely to have substantial implications for the maintenance and treatment of adolescent BED.

Background: Binge-eating disorder (BED) as a distinct eating disorder category and night eating syndrome (NES) as a form of Other Specified Feeding or Eating Disorders were recently included in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Objectives: This study sought to investigate the prevalence of BED and NES and associations with various forms of non-normative eating behavior and psychopathology in prebariatric patients. Setting: Within a consecutive multicenter registry study, patients in six bariatric surgery centers in Germany were recruited. Methods: Overall, 233 prebariatric patients were assessed using the Eating Disorder Examination and self-report questionnaires. Assessment was unrelated to clinical procedures. Results: Diagnostic criteria for full-syndrome BED and NES were currently met by 4.3% and 8.2% of prebariatric patients, respectively. In addition, 8.6% and 6.9% of patients met subsyndromal BED and NES criteria, respectively. Comorbid BED and NES diagnoses were present in 3.9% of patients. In comparison to patients without any eating disorder symptoms, patients with BED and NES reported greater emotional eating, eating in the absence of hunger, and more symptoms of food addiction. Moreover, differences between patients with BED and NES emerged with more objective binge eating episodes and higher levels of eating concern, weight concern, and global eating disorder psychopathology in patients with BED. Conclusions: BED and NES were shown to be prevalent among prebariatric patients, with some degree of overlap between diagnoses. Associations with non-normative eating behavior and psychopathology point to their clinical significance and discriminant validity.

This study sought to examine risk and onset patterns in anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). Women with AN (n=71), BN (n=66), BED (n=160) and non-psychiatric controls (n=323) were compared retrospectively on risk factors, symptom onset, and diagnostic migration. Eating disorder groups reported greater risk exposure than non-psychiatric controls. AN and BED differed on premorbid personality/behavioral problems, childhood obesity, and family overeating. Risk factors for BN were shared with AN and BED. Dieting was the most common onset symptom in AN, whereas binge eating was most common in BN and BED. Migration between AN and BED was rare, but more frequent between AN and BN and between BN and BED. AN and BED have distinct risk factors and onset patterns, while BN shares similar risk factors and onset patterns with both AN and BED. Results should inform future classification schemes and prevention programs.

Hintergrund. Für die durch wiederkehrende Essanfälle gekennzeichnete Binge Eating-Störung (BES) wurde die Kognitive Verhaltenstherapie (KVT) als Behandlungsmethode der Wahl etabliert. Zum Psychotherapieprozess, welcher das Therapieergebnis beeinflusst, ist jedoch wenig bekannt. Fragestellung. Da Untersuchungen zum Prozessaspekt der therapeutischen Adhärenz Unterschiede zwischen Patienten eines Therapeuten sowie zwischen verschiedenen Therapeuten belegen, soll der Einfluss von Patienten- und Therapeutenmerkmalen auf die therapeutische Adhärenz geprüft werden. Methode. In einer prospektiven, multizentrischen, randomisiert-kontrollierten Behandlungsstudie zum Wirksamkeitsvergleich von KVT und Internet-basierter angeleiteter Selbsthilfe (INTERBED) wurde die therapeutische Adhärenz in der KVT durch unabhängige Rater erfasst. Patienten- und Therapeutenmerkmale wurden mittels Interview und Selbstbericht erhoben. Ergebnisse. Soziodemografische Merkmale wie ein geringeres Bildungsniveau der Patienten und weibliches Geschlecht der Therapeuten wurden als signifikante Prädiktoren einer höheren therapeutischen Adhärenz identifiziert. Störungsspezifische Merkmale der Patienten waren nicht mit der therapeutischen Adhärenz assoziiert. Therapeutenmerkmale wie ein geringerer Ausbildungsgrad, eine geringere erlebte therapeutische Kompetenz und höhere Erwartungen sowie ein höheres emotionales Wohlbefinden der Therapeuten sagten eine höhere therapeutische Adhärenz vorher. Diskussion. Die etablierte hohe therapeutische Adhärenz erschien unabhängig vom Patienten, während einige Therapeutenmerkmale als Prädiktoren identifiziert wurden. Ungünstige Einflüsse auf die therapeutische Adhärenz bedürfen weiterer Erforschung und einer stärkeren Berücksichtigung in der Ausbildung von Therapeuten. / Background. Cognitive-behavioral therapy (CBT) has been established as the treatment of choice for binge-eating disorder (BED) which is characterized by recurrent binge eating episodes. However, only little is known about the impact of the psychotherapeutic process on treatment outcomes. Objectives. While studies concerning the process aspect of therapist adherence found differences between patients from one therapist as well as differences between therapists, the impact of patient and therapist characteristics on therapist adherence will be investigated. Methods. In a prospective multicenter randomized-controlled trial comparing CBT to Internet-based guided self-help (INTERBED), the therapist adherence to CBT was determined by independent raters. Patient and therapist characteristics were obtained via interview and self-report questionnaires. Results. Sociodemographic characteristics including lower education in patients and female sex in therapists were identified as predictors of higher therapist adherence. Disorder-specific characteristics of patients were not associated with the therapist adherence. Therapist characteristics including less postgraduate therapist training, lower self-rated therapeutic competence, and higher expectations as well as higher emotional well-being of therapists predicted higher therapist adherence. Conclusions. The high level of therapist adherence was mostly independent from patients, while some therapist characteristics were identified as predictors. Adverse impacts on therapist adherence should be investigated further and might be considered in therapeutic training.

Objective: Loss of control (LOC) eating is a salient indicator of eating disorder psychopathology in adolescents and is associated with marked distress. While research has focused on the relevance of episode size, clinical significance of LOC eating frequency has rarely been explored. Therefore, this study aimed at identifying LOC eating prevalence with respect to its recurrence and associated variables in a community-based sample. Method: Participants were 1643 adolescents, aged 12-20 years (62.4% female). Based on EDE-Q self-report, participants were categorized as those reporting recurrent (N = 156; 9.5%), non-recurrent (N = 226; 13.8%) and no LOC eating (N = 1261; 76.7%). Results: Adolescents with recurrent LOC eating reported clinically relevant and significantly greater eating disorder psychopathology, functional impairment and distress because of LOC eating, and a significantly higher body mass index (BMI, kg/m2) than adolescents with non-recurrent and those without LOC eating. Discussion: These results underline that LOC eating is a common eating behavior among adolescents in the community associated with clinical characteristics of eating disorders, and could therefore be a risk factor for developing full- or partial-syndrome eating disorders. Further research on the classification of eating disorders in adolescents with LOC eating and severity indicators is warranted.

Essstörungen sind prävalente psychische Störungen mit schwerwiegenden, oftmals langfristigen Auswirkungen auf die psychische und körperliche Gesundheit. Eine zunehmende Anzahl von klinischen Studien dokumentiert die Wirksamkeit verschiedener psychotherapeutischer Ansätze für spezifische Essstörungen. Im vorliegenden Themenheft 5 werden die Wirksamkeit von neuen Ansätzen zur Einzeltherapie und zur internet-basierten Rückfallprophylaxe, die Patientensicht auf die Therapie sowie die Relevanz von Faktoren des therapeutischen Prozesses bei verschiedenen Essstörungen beleuchtet. Weiterer Forschungsbedarf besteht insbesondere hinsichtlich des Prozesses und der Dissemination evidenzbasierter Psychotherapie für Essstörungen. / Eating disorders are prevalent psychiatric disorders with severe and longstanding 15 implications for mental and physical health. An increasing number of clinical studies documents the efficacy of certain psychotherapeutic approaches for specific eating disorders. This special issue addresses the efficacy of novel approaches in face-to-face individual therapy and Internet-based relapse prevention, patient views of treatment, and the relevance of therapeutic process factors for diverse eating disorders. Further research is particularly 20 warranted regarding the process and dissemination of evidence-based psychotherapy for eating disorders.